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General NPI Number Information
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NPI Number | 1164602504
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Entity Type | Organization
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Legal Business Name | RAINSVILLE EYE CLINIC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 463 MAIN ST W.
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City | RAINSVILLE
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State | AL
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Zip | 35986
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Country | US
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Telephone | 256-638-2020
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Fax | 256-638-7832
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Provider Business Mailing Address
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Address Line | PO BOX 2120
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City | RAINSVILLE
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State | AL
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Zip | 35986-2120
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Country | US
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Telephone | 256-638-2020
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Fax | 256-638-7832
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DIRK D MCGULLION
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Credential | OD
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Telephone | 256-638-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | S818TA058
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License Number State | AL
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